Public Reporting
Performance Management Programme Indicators Reporting: July 2009 to June 2010
All other indicators were achieved; with the exception of CVD Risk Assessment and Mammography. TaPasefika CVD Risk Assessment performance remain higher than both National and DHB performance levels. 
Performance Management Programme Indicator Reporting to December 2009
TaPasefika PHO Performace to December 2009 - Breast Screening
Breast screening referrals have improved since 2006 through engagement of enrolled women with Wellness Clinics and the support of Community Health Workers. Access to BSA breast screening mammograms has improved when the mobile BSA unit has parked at local shopping centres. In response to the 2009 slowdown in improvements, TaPasefika PHO has supported providers with a 2010 programme to locate and engage individual enrolled women, and link them to mammography. Future coverage results should reflect this.
TaPasefika Performance Cervical Screening to December 2009
TaPasefika providers continue to improve in the delivery of on-site well woman care including cervical cancer screening. Family discussion around 2009 media campaigns and the HPV programme have supported women in their decision to have a smear test.
TaPasefika Performance CVD Risk Assessment to December 2009
TaPasefika providers are leaders in assessing the cardiovascular disease risk of their patients. The completion of CardioVascular Disease risk assessments occurs more frequently when blood testing for lipid levels is performed on-site before the patient leaves the clinic. This was possible with a part payment for Nurse time through laboratory funding. The recent change in regional laboratory service contracts has changed this part-payment, forcing some providers to leave patients to access their blood test off-site.
TaPasefika Performance Diabetes Detection
TaPasefika providers are excellent at detecting diabetes. The apparent overtesting is an artifact of the denominator being an estimated prevalence.
TaPasefika Performance Diabetes Follow-up
TaPasefika providers are excellent at engaging people living with diabetes for their review of their diabetes care plan on an annual basis. Many people with diabetes are reviewed every 3months with the support of the Counties Manukau DHB Chronic Care Management programme.
TaPasefika Performance Flu Vaccine Coverage 65Years+
TaPasefika providers continue to improve in their delivery of Flu vaccination to enrolled older people. Since 2006, flu vaccination coverage of enrolled people over the age of 65years has more than doubled.
Prevention of sickness with immunization needs to continue to be a priority.
TaPasefika Performance Child Immunisations - Under 2s
Despite the heavy impact of H1N1 influenza on our high needs population and services in 2009, TaPasefika providers have reached their highest level of immunization of enrolled 2years olds since 2006. Every aspect of child immunization accessibility has been reviewed. Improvements to minimize missed opportunities and vaccine preventable infections are being made. Prevention with child immunization needs to continue to be a priority.
TaPasefika Performance GP Referred Lab Expenditure
TaPasefika providers have reviewed laboratory referrals and updated them in line with recently available best practice and evidence.
TaPasefika Performance GP Referred Pharmaceutical Expenditure
TaPasefika providers prescribe generically most of the time to limit the pharmacy costs to the patient. The economic recession that started in October 2008 has had a significant impact on low income households, including the TaPasefika enrolled population. With many families previously just making ends meet, the recession limited weekly cashflow even further. When medication has been clinically indicated, many enrolled patients have negotiated fewer medications, opting instead for non-pharmacological alternatives. Many more patients, including those who do not meet High Health User card criteria, have opted to not get their prescription filled post recession. Equitable access to indicated medications as supported by best evidence and practice should be a focus of quality care.
The National Performance Management Programme
TaPasefika entered the PHO Performance Management Programme in January 2006. It is important to note population variations for the context in which TaPasefika and its providers work:
% People by Ethnicity |
TaPasefika |
CMDHB |
National |
NZ Maori |
13% |
17% |
15% |
Pacific Peoples |
68% |
21% |
7% |
European/Other |
19% |
62% |
78% |
Achievement of indicators for the July 2008-June 2009 year was slightly compromised by the Swine Flu Pandemic that hit TaPasefika in the last quarter of 2009. This was particularly the case for Cervical smears, mammography and under two immunisations. Please note that TaPasefika’s Under Two Immunisation for high needs is 65.10%, above the CMDHB average of 57.89% for 2009.
All other indicators were achieved; with CVD and Diabetes indicators achieving performance well above local and national performance levels.
|
|
|
|
|
|
|
|
- |
28.08 |
32.55 NZ 23.04 DHB 26.34 |
32.55 |
4.47% |
P |
|
- |
32.44 |
40.98 NZ 21.52 DHB 36.66 |
40.00 |
8.54% |
P |
|
- |
139.04 |
148.61 NZ 106.02 DHB 128.27 |
90.00 |
9.57% |
P |
|
- |
102.39 |
111.63 NZ 56.43 DHB 60.36 |
80.00 |
9.24% |
P |
|
35.50
|
52.99 NZ 61.7 DHB 55.29 |
54.98 NZ 63.89 DHB 58.49 |
55.99 |
1.99%
Needed 3% to achieve target |
O |
|
29.61
|
44.05 NZ 51.61 DHB 46.47 |
46.34 NZ 55.58 DHB 49.16 |
48.05 |
2.29%
Needed 4% to achieve target |
O |
|
34.84 |
52.68 NZ 60.32 DHB 58.9 |
57.04 NZ 65.84 DHB 62.62 |
56.41 |
4.36% |
P |
|
34.94 |
52.89 NZ 60.32 DHB 58.9 |
57.89 NZ 63.28 DHB 62.04 |
55.77 |
5% |
P |
|
51.41 |
68.42 NZ 64.57 DHB 43.67 |
65.10 NZ 69.13 DHB 57.89 |
72.21 |
-3.32%
Needed 3.79% to achieve target |
O |
|
89.61 |
98.15 NZ 98.84 DHB 98.45 |
97.34 NZ 99.08 DHB 98.8 |
>=99.5 |
0% |
P |
|
|
1.14 NZ 1.1 DHB 1.22 |
1.37 NZ 1.11 DHB 1.23 |
>=1 |
0% |
P |
|
139.37 |
104.78 NZ 85.51 DHB 103.42 |
103.76 NZ 80.21 DHB 101.36 |
106.0 |
-1.02% |
P |
|
77.01 |
95.56 NZ 94.31 DHB 92.54 |
71.01 NZ 88.34 DHB 87.16 |
<=100 |
-24.55% |
P |
2009 BPAC PHO Reports
Best Practice Reporting indicate: To prevent cardiovascular mortality and morbidity, risk assessment should be performed every 5years to detect remediable factors. A higher proportion of TaPasefika patients have their cardiovascular risk assessed than the national population.
% Male Patients had Lipids Tested |
TaPasefika |
National |
NZ Maori (35-44y) |
16.8% |
14.0% |
Pacific Peoples (35-44y) |
21.7% |
19.8% |
European/Other (45-54y) |
46.7% |
33.1% |
A higher proportion of TaPasefika patients have high cholesterol treated with a statin.
% Male Patients Dispensed Statins |
TaPasefika |
National |
NZ Maori (35-44y) |
6.1% |
4.4% |
Pacific Peoples (35-44y) |
10.9% |
6.8% |
European/Other (45-54y) |
30.2% |
13.3% |
People with diabetes are having their diabetes management adequately monitored.
% Patients on Oral Antidiabetic Medication had HbA1C tested (35years+) |
TaPasefika |
National |
NZ Maori |
91.5% |
85.4% |
Pacific Peoples |
92.3% |
88.3% |
European/Other |
93.6% |
86.8% |
People with diabetes are having their kidney function adequately monitored.
|
TaPasefika |
CMDHB |
National |
% Patients on Oral Antidiabetic Medication had Annual Creatinine Blood Test (30-70years) |
92% |
88% |
81% |
% Patients on Oral Antidiabetic Medication had Annual Microalbumin Urine Test (30-70years) |
90% |
82% |
73% |
A higher proportion of TaPasefika patients have high blood pressure, left ventricular heart dysfunction, and kidney disease requiring ACE inihibitors / Angiotension Receptor Blockers medication.
% Patients Dispensed ACE/ARB (35years+) |
TaPasefika |
National |
NZ Maori |
23.9% |
18.0% |
Pacific Peoples |
28.9% |
20.5% |
European/Other |
37.3% |
17.4% |
Relative to Pacific patients who make up the majority of enrolees, Maori appear to have the lowest access to testing and prescriptions and European/Other ethnicity patients to have the highest access. This access disparity within TaPasefika has been highlighted with clinical leaders, and will be explored and monitored.